Osteoporosis is a bone disease caused by a disruption in the normal bone remodeling process and leads to an increased risk of fracture, most commonly in the hip, wrist or spine. In 2007, it was estimated that 10 million people over the age of 50 had osteoporosis and approximately 34 million had low bone mass, placing them at risk for developing the disease. Currently, there are multiple FDA-approved treatment options available for the treatment or prevention or osteoporosis.
Bisphosphonates
One of the mainstays in osteoporosis treatment and prevention are bisphosphonates. This class of drugs inhibits bone breakdown, preserves bone mass and increases bone density in the spine and hip, reducing the risk of fractures. FDA-approved bisphosophonates include risedronate (Actonel), ibandronate (Boniva), alendronate (Fosamax) and zolendronic acid (Reclast). Depending on the brand, they can be given intravenously one to four times a year or tablets can be taken daily, weekly or monthly. Side effects include nausea, abdominal pain, difficulty swallowing, inflammation of the esophagus or esophageal ulcers. Rare but serious side effects may include osteonecrosis of the jaw, arrhythmias or visual disturbances. Bisphosphonate tablets should be taken with a full glass of water first thing in the morning and you should avoid bending over or lying down for at least 30 minutes after taking a dose.
Calcitonin
If you have been postmenopausal for five or more years, calcitonin (Fortical or Miacalcin) may be another possible treatment option. Calcitonin is a hormone that reduces bone resorption and may also slow bone loss in the spine. It is usually prescribed as a nasal spray, but it is also available as an injection. The nasal spray should be used once daily and common side effects include back and joint pain, headache and nasal symptoms, such as runny nose, dryness, crusting, sores, redness, irritation, nosebleed or tenderness. It is generally not as potent as other medications used in the treatment of osteoporosis, so it is usually reserved for patients that are unable to tolerate other treatments.
Estrogen Therapy or Estrogen Plus Progestin Hormone Therapy
Estrogen therapy and estrogen plus progestin hormone therapy are FDA-approved for the prevention of osteoporosis in postmenopausal women. Some examples of brands of estrogen and hormone therapies include Estrace, Premarin, FemHrt and Prempro. Estrogen and hormone therapies have been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of spine, hip and other fractures. They are available as tablets, transdermal patches, creams, or gels and come in a wide variety of doses, allowing your health-care provider to customize your therapy. Estrogen or hormone therapies increase the risk of blood clots, endometrial cancer, breast cancer and heart disease, so they are not recommended first line of prevention of osteoporosis and should be used for the shortest time possible.
Raloxifene
Raloxifene (Evista) is a selective-estrogen-receptor modulator (SERM) approved for the prevention and treatment of osteoporosis in postmenopausal women. It is taken once a day and improves bone mass and reduces the risk of spinal fracture; it may also have a protective effect on breast tissue when compared to estrogen or hormone therapy. Side effects include an increase in hot flashes, blood clots, leg cramps and fluid retention. Women with an increased risk for stroke should not take raloxifene.
Teriparatide
Teriparatide (Forteo) is an FDA-approved injectable medication used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for fractures. It stimulates new bone growth, restores bone structure and reduces the risk of fractures. It is administered once a day and should not be used for longer than two years. Common side effects include dizziness, leg cramps, nausea, joint or muscle pain and increased levels of calcium in the blood and urine.
